• calf raise
• electroacupuncture
• muscle hardness
• ultrasound real-time tissue elastography

• advance imaging
• endoscopic ultrasound
• shear wave elastography
• strain elastography

• aerobic exercise
• muscle hardness
• ultrasound real-time tissue elastography

• Chronic pancreatitis
• Endoscopic ultrasound-guided
• Lymph node
• Pancreatic cancer
• Strain histogram
• Strain ratio

• Elasticity Imaging Techniques/methods
• Endosonography/methods
• Humans
• Pancreas/pathology
• Pancreatic Neoplasms/pathology
• Pancreatitis, Chronic/diagnostic imaging

• Diagnosis, Differential
• Elasticity Imaging Techniques/methods
• Humans
• ROC Curve
• Sensitivity and Specificity
• Thyroid Nodule/diagnostic imaging
• Thyroid Nodule/pathology

• Aspiration
• Biopsy
• Cancer
• Endoscopic ultrasound-fine needle aspiration
• Endoscopic ultrasound-fine needle biopsy
• Endoscopic ultrasound-guided tissue acquisition

• autoimmune pancreatitis
• chronic pancreatitis
• endoultrasonography
• gastro-intestinal lesion
• lymph node
• pancreatic solid lesion
• shear wave elastography
• strain elastography
• subepithelial lesion

Endoscopic ultrasound (EBUS) strain elastography can diagnose intrathoracic benign and malignant lymph nodes (LNs) by reflecting the relative stiffness of tissues. Due to strong subjectivity, it is difficult to give full play to the diagnostic efficiency of strain elastography. This study aims to use machine learning to automatically select high-quality and stable representative images from EBUS strain elastography videos.

LNs with qualified strain elastography videos from June 2019 to November 2019 were enrolled in the training and validation sets randomly at a quantity ratio of 3:1 to train an automatic image selection model using machine learning algorithm. The strain elastography videos in December 2019 were used as the test set, from which three representative images were selected for each LN by the model. Meanwhile, three experts and three trainees selected one representative image severally for each LN on the test set. Qualitative grading score and four quantitative methods were used to evaluate images above to assess the performance of the automatic image selection model.

A total of 415 LNs were included in the training and validation sets and 91 LNs in the test set. Result of the qualitative grading score showed that there was no statistical difference between the three images selected by the machine learning model. Coefficient of variation (CV) values of the four quantitative methods in the machine learning group were all lower than the corresponding CV values in the expert and trainee groups, which demonstrated great stability of the machine learning model. Diagnostic performance analysis on the four quantitative methods showed that the diagnostic accuracies were range from 70.33% to 73.63% in the trainee group, 78.02% to 83.52% in the machine learning group, and 80.22% to 82.42% in the expert group. Moreover, there were no statistical differences in corresponding mean values of the four quantitative methods between the machine learning and expert groups (p >0.05).

The automatic image selection model established in this study can help select stable and high-quality representative images from EBUS strain elastography videos, which has great potential in the diagnosis of intrathoracic LNs.

• endobronchial ultrasound
• image selection
• lymph nodes
• machine learning
• strain elastography

• artificial intelligence
• choledocholithiasis
• computer-aided diagnosis
• endoscopic ultrasound
• pancreatic cancer

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) technology is important in the diagnosis of intrathoracic benign and malignant lymph nodes (LNs). With the development of EBUS imaging technology, its role in noninvasive diagnosis, as a supplement to pathology diagnosis, has been given increasing attention in recent years. Many studies have explored qualitative and quantitative methods for the three EBUS modes, as well as a variety of multimodal analysis methods, to find the optimal method for the noninvasive diagnosis using EBUS for LNs. Here, we review and comment on the research methods and predictive diagnostic value, discuss the existing problems, and look ahead to the future application of EBUS imaging.

• endobronchial ultrasound
• lymph node qualitative analysis
• quantitative analysis
• sonographic feature

• Acoustic coupler
• Intratester and intertester measurement reliability
• Shoulder muscles
• Strain ultrasound elastography
• Tissue stiffness

Endoscopic ultrasound (EUS) and endoscopic ultrasound elastography (EUS-E) simulation lessens the learning curve; however, models lack realism, diminishing competitiveness.

To standardize the mechanical properties of polyvinyl alcohol (PVA) hydrogel for simulating organs and digestive lesions.

PVA hydrogel (Sigma Aldrich, degree of hydrolysis 99%) for simulating EUS/EUS-E lesions was investigated in Unidad de Investigación y Desarrollo Tecnológico at Hospital General de México “Dr. Eduardo Liceaga”, Mexico City. We evaluated physical, contrast, elasticity and deformation coefficient characteristics in lesions, applying Kappa’s concordance and satisfaction questionnaire (Likert 4-points).

PVA hydrogel showed stable mechanical properties. Density depended on molecular weight (MW) and concentration (C). PVA bblocks with the greatest density showed lowest tensile strength (r = -0.8, P = 0.01). Lesions were EUS-graphically visible. Homogeneous and heterogeneous examples were created from PVA blocks or PVA phantoms, exceeding (MW₂ = 146000-186000, C₉ = 15% and C₁₀ = 20%) with a density under (MW₁ = 85000-124000, C₁ = 7% and C₂ = 9%). We calculated elasticity and deformation parameters of solid (blue) areas, contrasting with the norm (Kappa = 0.8; high degree of satisfaction).

PVA hydrogels were appropriate for simulating organs and digestive lesions using EUS/EUS-E, facilitating practice and reducing risk. Repetition amplified skills, while reducing the learning curve.

• Endoscopic ultrasound simulators in endoscopy
• Polyvinyl alcohol
• Endoscopic ultrasound
• Endoscopic ultrasound elastography
• Strain
• Elasticity

• Elasticity Imaging Techniques
• Humans
• Mexico
• Models, Theoretical
• Polyvinyl Alcohol

The objective of this study was to assess the serum ferritin level and quantitate ultrasound elastography as a marker to distinguish dogs with benign and malignant liver tumors.

Twenty-eight dogs were determined the serum ferritin and ultrasound elastography by using fine-needle aspiration biopsy.

Our results demonstrated that dogs with malignant liver tumors had significantly higher mean serum ferritin concentrations than those with benign liver tumors (p = 0.004). The mean intensity of blue and red colors from elastography was greater in the malignant than those in the benign group, especially for the blue color, meaning that lesions showed more hard tissue. Additionally, histograms of blue color in the malignant tended to be higher than the benign group.

We suggested that quantitative ultrasound elastography and serum ferritin concentration comprise an alternative and non-invasive diagnostic method that could be used to predict the type of liver tumors in dogs.

• Dogs
• ferritin
• liver
• tumor
• ultrasound

• Complication rate
• EUS
• screen orientation

• EBUS
• Lung cancer
• NSCLC
• elastography
• endobronchial ultrasound
• strain ratio

• EBUS
• elastography
• lung cancer

• Contrast enhanced endoscopic ultrasound
• Endoscopic ultrasound elastography
• Endoscopic ultrasound-guided drainage
• Endoscopic ultrasound-guided fine needle aspiration
• Endosonography

• Adult
• Aged
• Endosonography/methods
• Endosonography/trends
• Female
• Gastroenterology/methods
• Gastroenterology/trends
• Humans
• Male
• Middle Aged
• Young Adult

• Diagnosis
• Elastography
• Endoscopic ultrasound
• Stiffness

• elastography
• endobronchial ultrasound
• endobronchial ultrasound-guided transbronchial needle aspiration
• malignancy
• strain ratio

• Elastography
• Musculoskeletal
• Shear-wave
• Strain
• Ultrasound

• Adult
• Elasticity Imaging Techniques/methods
• Female
• Healthy Volunteers
• Humans
• Male
• Middle Aged
• Muscle, Skeletal/diagnostic imaging

• Achilles tendon
• Reliability
• Sonoelastography

This article presents possible applications of ultrasound elastography in musculoskeletal imaging based on the available literature, as well as the possibility of extending indications for the use of elastography in the future. Ultrasound elastography (EUS) is a new method that shows structural changes in tissues following application of physical stress. Elastography techniques have been widely used to assess muscles and tendons in vitro since the early parts of the twentieth century. Only recently with the advent of new technology and creation of highly specialized ultrasound devices, has elastography gained widespread use in numerous applications.

The authors performed a search of the Medline/PubMed databases for original research and reviewed publications on the application of ultrasound elastography for musculoskeletal imaging.

All publications demonstrate possible uses of ultrasound elastography in examinations of the musculoskeletal system. The most widely studied areas include the muscles, tendons and rheumatic diseases. There are also reports on the employment in vessel imaging.

The main limitation of elastography as a technique is above all the variability of applied pressure during imaging, which is operator-dependent. It would therefore be reasonable to provide clear guidelines on the technique applied, as well as clear indications for performing the test. It is important to develop methods for creating artifact-free, closed-loop, compression-decompression cycles.

The main advantages include cost-effectiveness, short duration of the study, non-invasive nature of the procedure, as well as a potentially broader clinical availability. There are no clear guidelines with regard to indications as well as examination techniques.

Ultrasound elastography is a new and still poorly researched method. We conclude, however, that it can be widely used in the examinations of musculoskeletal system. Therefore, it is necessary to conduct large, multi-center studies to determine the methodology, indications and technique of examination.

• Elasticity Imaging Techniques
• Ultrasonography
• Ultrasonography, Doppler, Color

• Diagnosis
• EUS elastography
• Esophageal cancer
• Lymph node
• Metastasis

• Elastography
• Imaging
• Lymph node
• Shear wave elastography
• Staging
• Strain
• Ultrasound

• Elasticity Imaging Techniques
• Humans
• Lymph Nodes/diagnostic imaging
• Lymphatic Diseases/diagnostic imaging
• Ultrasonics

Ultrasound elastography is a widely used technique for assessing the mechanical characteristics of tissues. Although there are several ultrasound elastography techniques, strain elastography (SE) is currently the most widely used technique for visualizing an elastographic map in real time. Among its various indications, SE is especially useful in evaluating the musculoskeletal system. In this article, we review the SE techniques for clinical practice and describe the images produced by these techniques in the context of the musculoskeletal system. SE provides information about tissue stiffness and allows real-time visualization of the image; however, SE cannot completely replace gray-scale, color, or power Doppler ultrasonography. SE can increase diagnostic accuracy and may be useful for the follow-up of benign lesions.

• Elasticity imaging techniques
• Soft tissue neoplasms
• Ultrasonography

• Characterization
• Elastography
• Endoscopic ultrasound
• Lymph nodes
• Pancreas

• Diagnosis, Differential
• Elasticity
• Elasticity Imaging Techniques/methods
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Endosonography
• Humans
• Lymph Nodes/diagnostic imaging
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/pathology
• Pancreatitis, Chronic/diagnostic imaging
• Pancreatitis, Chronic/pathology
• Predictive Value of Tests
• Reproducibility of Results

Ultrasound elastography is an imaging procedure that can assess the biomechanical characteristics of different tissues. The aim of this study was to define the diagnostic value of the endobronchial ultrasound (EBUS) elastography strain ratio of mediastinal lymph nodes in patients with a suspicion of lung cancer. The diagnostic values of the strain ratios were compared with the EBUS brightness mode (B-mode) features of selected mediastinal lymph nodes and with their cytological diagnoses.

This prospective, single-centre study enrolled patients with an indication for biopsy and mediastinal staging after a non-invasive diagnostic workup of a lung tumour. EBUS with standard B-mode evaluation and elastography with strain ratio measurement were performed before endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

Thirty-three patients with 80 suspicious mediastinal lymph nodes were included. Malignant infiltration was confirmed in 34 (42.5%) lymph nodes. The area under the receiver operating characteristic curve for the strain ratio was 0.87 (p < 0.0001). At a strain ratio ≥ 8, the accuracy for malignancy prediction was 86.25% (sensitivity 88.24%, specificity 84.78%, positive predictive value [PPV] 81.08%, negative predictive value [NPV] 90.70%). The strain ratio is more accurate than conventional B-mode EBUS modalities for differentiating between malignant and benign lymph nodes.

EBUS-guided elastography with strain ratio assessment can distinguish malignant from benign mediastinal lymph nodes with greater accuracy than conventional EBUS modalities. This new method may reduce the number of mediastinal EBUS-TBNAs and thus reduce the invasiveness and expense of mediastinal staging in patients with non-small lung cancer (NSCLC).

• cancer staging
• elastography
• endobronchial ultrasound
• lung cancer
• needle biopsy

• Elastic strain ratio
• Elasticity scores
• Greater omentum
• Ultrasound elastography
• Ultrasound-guided biopsy

• elastography
• endoscopic ultrasound
• endoscopic-ultrasound elastography
• lymph node
• ultrasound

• diagnostic accuracy
• focal lesions
• phantom studies
• ultrasound elastography

• Cáncer de pulmón
• Elastografía
• Elastography
• Endobronchial ultrasound
• Endoscopic ultrasound
• Lung cancer
• Ultrasonografía endobronquial
• Ultrasonografía endoscópica

Endoscopic ultrasound (EUS) is one of the best diagnostic methods for diseases of the digestive tract and surrounding organs. Whereas EUS-guided fine needle aspiration (FNA) has been very useful for providing histological confirmation for previously hard to reach lesions, elastography is aiming to obtain a “virtual biopsy” by assessing differences in elasticity between the normal and pathological – usually malignant – tissue. A question that arises is whether EUS-elastography has reached a stage where it might successfully supplant the use of EUS-FNA in some of its clinical indications. The main indications of EUS-guided FNA are listed in this article and published data on the usage of elastography in these settings is reviewed for each one. In some of the indications, a plethora of studies have been published, notably for the evaluation of solid pancreatic masses and lymph nodes, while in others there is little relevant data (submucosal masses, left liver lesions, left adrenal masses), or elastography simply is not suitable as a diagnostic means (cystic lesions). Our conclusion is that elastography is not yet ready to replace EUS-FNA in its indications, but should complement it in various settings, especially for the assessment of lymph nodes. It can only be considered an alternative on a case-by-case basis, in situations where FNA is regarded as a contraindication. Furthermore, it could be used in conjunction with other imaging techniques, such as contrast-enhanced EUS, in order to further improve the accuracy of non-invasive EUS assessment, possibly making the case for a more limited or targeted use of EUS-FNA in selected cases.

• Elastography
• endoscopic ultrasound
• fine needle aspiration

• endoscopic ultrasound
• gastroesophageal junction adenocarcinoma
• lymph node metastases

The aim of this study was to evaluate the performance of strain elastography in an elasticity phantom and to assess which factors influenced visual scoring, strain histograms and strain ratios. Furthermore this study aimed to evaluate the effect of observer experience on visual scorings.

Two operators examined 20 targets of various stiffness and size (16.7 to 2.5 mm) in an elasticity phantom at a depth of 3.5 cm with a 5–18 MHz transducer. Two pre-settings were used yielding 80 scans. Eight evaluators, four experienced, four inexperienced, performed visual scorings. Cut-offs for semi-quantitative methods were established for prediction of target stiffness. Data was pooled in two categories allowing calculations of sensitivity and specificity. Statistical tests chi-square test and linear regression as relevant.

Strain ratios and strain histograms were superior to visual scorings of both experienced and inexperienced observers (p = 0.025, strain histograms vs. experienced observers, p<0.001, strain histograms vs. inexperienced observers, p = 0.044 strain ratios vs. experienced observers and p = 0.002 strain ratios vs. inexperienced observers). No significant difference in predicting target stiffness between strain ratios and strain histograms (p = 0.83) nor between experienced and inexperienced observers (p = 0.054) was shown when using four categories. When pooling data in two groups (80 kPa/45 kPa vs. 14/8 kPa) the difference between the observers became significant (p<0.001). Target size had a significant influence on strain ratios measurements (p = 0.017) and on visual scorings (p<0.001) but not on the strain histograms(p = 0.358). Observer experience had significant effect on visual scorings(p = 0.003).

Strain ratios and strain histograms are superior to visual scoring in assessing target stiffness in a phantom. Target size had a significant impact on strain ratios and visual scoring, but not on strain histograms. Experience influenced visual scorings but the difference between experienced and inexperienced observers was only significant when looking at two classes of target stiffness.

• Elasticity
• Elasticity Imaging Techniques/methods
• Humans
• Linear Models
• Observer Variation
• Phantoms, Imaging
• Polymers/chemistry
• Pressure
• Reproducibility of Results
• Sensitivity and Specificity
• Ultrasonography/methods

• Endoscopic ultrasound
• Lymph node metastasis
• Lymph nodes
• Lymphoma
• Ultrasound

• Contrast Media
• Elasticity Imaging Techniques
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Endosonography
• Humans
• Image Interpretation, Computer-Assisted
• Imaging, Three-Dimensional
• Lymph Nodes/diagnostic imaging
• Lymph Nodes/pathology
• Lymphatic Diseases/diagnostic imaging
• Lymphatic Diseases/pathology
• Lymphatic Metastasis
• Predictive Value of Tests
• Prognosis

• endoscopic ultrasound
• gastroesophageal junction adenocarcinoma
• lymph node metastases